Sensor guided catheter navigation system

ABSTRACT

A method and a system for producing images of a subject, such as the heart of a human being. The method may comprise acquiring ultrasound images of the subject with a catheter comprising a position sensor. The method may also comprise capturing a plurality of 4D surface registration points in the acquired ultrasound images corresponding to points on the subject. The method may also comprise registering, in space and time, a high-resolution 4D model of the subject with the plurality of 4D surface registration points. The method may also comprise displaying high resolution, real-time images of the subject during a medical procedure based on the registration of the high resolution 4D model to the 4D surface registration points. Embodiments of the present invention are especially useful in left atrium ablation procedures.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.14/691,048, filed 20 Jun. 2015 (the '048 application), which is acontinuation of U.S. application Ser. No. 13/915,974, filed 12 Jun. 2013(the '974 application), now U.S. Pat. No. 9,017,260, which is acontinuation of U.S. application Ser. No. 13/167,400, filed 23 Jun. 2011(the '400 application), now U.S. Pat. No. 8,480,588, which is acontinuation of U.S. application Ser. No. 12/083,044, filed 23 Oct. 2008(the '044 application), now U.S. Pat. No. 7,981,038, which is a nationalstage of international application no. PCT/US2006/039693, filed 11 Oct.2006 (the '693 application), now expired, which claims the benefit ofpriority to U.S. application No. 60/725,368, filed 11 Oct. 2005 (the'368 application), now expired. The '048 application, the '974application, the '400 application, the '044 application, the '693application, and the '368 application are each hereby incorporated byreference as though fully set forth herein.

BACKGROUND OF THE INVENTION

a. Field of the Invention

The present invention relates generally to catheters and catheternavigation systems.

b. Background Art

Recent years have witnessed an expanding need for percutaneous,endocardium-based cardiac interventions, including ablation, injection,and device deployment. These interventions are generally not focal, butrather involve a broad region of endocardial anatomy. This anatomy iscomplex topographically, as well as motile. Current modalities forreal-time intraoperative endocardial imagining and navigation are highlyinaccurate, which has been the cause of procedure inefficiency andcomplications.

One such procedure is catheter ablation of the left atrial endocardium.This procedure is performed in an attempt to cure atrial fibrillation, acommon heart rhythm disorder. The left atrium, as noted above, has acomplex topography and motility. At present, the ablation procedure isperformed by attempting to “register” preoperative four-dimensionalimaging data (derived from computed tomography) and with two-dimensionalintraoperative imaging data derived from intracardiac echocardiographyand fluoroscopy). This is laborious, highly operator-dependent (whichprohibits dissemination) and inaccurate.

Typically, two major sensor systems are used during ablation proceduresto assist clinicians to navigate catheters: (1) a magnetic trackingsystem, which can track the 3D position of the catheter tip and yaw,pitch, and roll of the catheter; and (2) intracardiac ultrasound imagingsensor, which can generate a 2D section view in real time inside theheart chambers. Sometimes X-ray pictures are used as well. Apparently,all these sensors are used independently. That is, an ultrasound-imagingsensor is used to see visually if the ablation catheter is touching thehard wall and the magnetic tracking system is used to visualize theablation sites without any relative position information to the heart.

In order to visualize the catheter's position relative to the heart, theregistration must be done between the magnetic tracking system and aheart model derived from a CT scan or an MRI captured prior to surgery.Some similar 3D registration systems are available for surgery of rigidbody parts, such as hipbone surgery. Software such as BioSense Webster'sCARTOMERGE can be used to do the 3D registration between the magnetictracking system and the 3D heart model from the CT scan. These systemsbasically do the registration based on 3D shape. In order to do theregistration, a set of registration points needs to be captured. Thatis, clinicians need to move a probe or catheter whose position istracked to touch the surface of the bones or heart wall and record allthose positions.

These systems work well with rigid or almost rigid human body parts,such as bones or brain. In contrast, the shape of the human heartchanges dramatically through every cardiac cycle. Also, the respirationor breath of a person can also change the pressure of the person's lungand eventually change the shape of the person's heart.

Relevant prior art includes U.S. Pat. No. 6,556,695, which discloses amethod and system for high resolution medical images in real-time toassist physicians in the performance of medical procedures. Thedisclosed method includes: acquiring image data of the subject anatomyand reconstructing an image which is a high resolution model of thesubject anatomy; performing a medical procedure in which the subjectanatomy is imaged in real-time by acquiring low resolution images at ahigh frame rate; registering the high resolution model of the subjectanatomy with each acquired low resolution image; and displaying to thephysician in real-time images of the registered high resolution model ofthe anatomy. The high-resolution model may be a 2D or 3D image of staticanatomy, or it may be a 4D model in which the fourth dimension depictschanges in the anatomy as a function of time, cardiac phase, respiratoryphase, or the like. The creation of this model is performed using a highresolution imaging modality and it may be done prior to performing themedical procedure. The registration of the high resolution model isperformed in real-time and includes a 2D or 3D spatial orientation aswell as a registration in time or phase when the model depicts changinganatomy.

BRIEF SUMMARY OF THE INVENTION

In one general aspect, the present invention is directed to a method forproducing images of a subject, such as the heart of a human being.According to various embodiments, the method comprises acquiringultrasound images of the subject (e.g., the inner walls of the subject'sheart) with a catheter that comprises a position sensor. The method alsocomprises capturing a plurality of 4D surface registration points in theacquired ultrasound images corresponding to points on the subject (e.g.,points on the inner walls of the subject's heart). The method alsocomprises registering, in space and time, a high-resolution 4D model ofthe subject (e.g., a 4D-heart model) with the plurality of 4D surfaceregistration points. The method may also comprise displaying highresolution, real-time images of the subject during a medical procedurebased on the registration of the high resolution 4D model to the 4Dsurface registration points. In that way, as the clinician (e.g.,surgeon) moves the catheter as part of a medical procedure, theclinician may be presented with real-time, high resolution 3D images ofthe subject (rather than ultrasound images), which may aid the clinicianin the procedure. Also, unlike the prior art where the clinician has toactually touch the catheter to the subject to collect the registrationpoints, the registration points can be captured with a “virtual touch”with the present invention by which tens of thousands of high qualitysurface points can be captured within a few minutes without physicallytouching the catheter to the subject. Embodiments of the presentinvention are especially useful in left atrium ablation procedures,which is a procedure sometimes used in an attempt to cure atrialfibrillation, although it should be recognized that the presentinvention could be used for other types of procedures and for differentparts/organs of the human body.

According to various implementations, the registration of the highresolution 4D model of the subject with the plurality of 4D surfaceregistration points may be based on data regarding the position of thecatheter and a timing signal (e.g., an ECG signal). Also, the highresolution 4D model may be generated from a series of 3D models atsuccessive time points, such CT scans at different points of a cardiaccycle. The registration process may involve iteratively determining atransformation function that aligns the 4D surface registration pointsto the 4D model so that the 4D surface registration points are on the 4Dmodel (e.g., in the inner heart walls). The registration process mayfurther involve refining the registration based on a free-form non-rigidregistration.

In another general aspect, the present invention is directed to acatheter navigation system. According to various embodiments, thecatheter navigation system may comprise a catheter that comprises anultrasound transducer and a magnetic position sensor. The system alsocomprises a position tracking system for tracking the position of thecatheter based on signals received by the magnetic position sensor. Inaddition, the system comprises an image processing module incommunication with the catheter and the position tracking system for:(i) capturing a plurality of 4D surface registration points from aplurality of ultrasound images of a subject acquired by the catheter;and (ii) registering, in time and space, a high resolution 4D model ofthe subject with the plurality of 4D surface registration points.

In various implementations, the system may also comprise a display fordisplaying high resolution, real-time images of the subject during amedical procedure based on the registration of the high resolution 4Dmodel to the 4D surface registration points. Additionally, theimage-processing module may register the high-resolution 4D model of thesubject with the plurality of 4D surface registration points byiteratively determining a transformation function that aligns the 4Dsurface registration points to the 4D model so that 4D surfaceregistration points are on the 4D model. Also, the image-processingmodule may refine the registration based on a free-form non-rigidregistration. In addition, the high resolution 4D model may be based on3D CT scans of the subject generated at successive time points (such asvarious points of a cardiac cycle).

In another general aspect, the present invention is directed to acomputer readable medium having stored thereon instructions, which whenexecuted by a processor, cause the processor to: (1) capture a pluralityof 4D surface registration points from a plurality of input ultrasoundimages corresponding to points on a subject (e.g., inner walls of thesubject's heart); and (2) register, in space and time, a high resolution4D model of the subject with the plurality of surface registrationpoints. The computer readable medium may also include instructions whichwhen executed by the processor cause the processor to display the highresolution, real-time images of the subject during a medical procedureon the subject based on the registration of the high resolution 4D modelto the 4D surface registration points.

In yet another general aspect, the present invention is directed to amethod of performing a medical procedure on a subject. According tovarious embodiments, the method comprises inserting, by a clinician(e.g., a surgeon), a first catheter into the subject (such as the heartof the subject), wherein the first catheter comprises an ultrasonictransducer. The method also comprises acquiring ultrasound images of thesubject with the first catheter and capturing, with a programmedcomputer device in communication with the catheter, a plurality of 4Dsurface registration points in the acquired ultrasound imagescorresponding to points on the a portion of the subject (e.g., the innerheart walls of the subject). The method may further compriseregistering, with the programmed computer device, a high-resolution 4Dmodel of the subject with the plurality of surface registration points.The method may also comprise displaying, on a display in communicationwith the computing device, high resolution, real-time images of thesubject during the medical procedure based on the registration of thehigh resolution 4D model to the 4D surface registration points.

In various implementations, the first catheter further comprises aninterventional device, and the method may further comprise the steps of:(1) navigating, by the clinician, the position of the first catheterbased on the displayed high resolution images; and (2) performing, bythe clinician, a procedure using the interventional device on thesubject.

In another general implementation, the method may comprise inserting asecond catheter into the subject, wherein the second catheter comprisesan interventional device. The method may further comprise the steps of:(1) navigating, by the clinician, the position of the second catheterbased on the displayed high-resolution images; and (2) performing, bythe clinician, a procedure on the subject with the interventional deviceof the second catheter.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the present invention are described herein by wayof example in conjunction with the following figures wherein:

FIG. 1 is a diagram of a catheter navigation system according to variousembodiments of the present invention;

FIG. 2 is a diagram of the distal end of a catheter for use in thecatheter navigation system of FIG. 1 according to various embodiments ofthe present invention;

FIG. 3 is a flow chart of the process flow of the image-processingmodule of the catheter navigation system of FIG. 1 according to variousembodiments of the present invention;

FIG. 4A shows a CT scan of a human heart, FIG. 4B shows a segmented CTscan, and FIGS. 4C and 4D show models of the heart at different times inthe cardiac cycle;

FIGS. 5A and 5B shows an example of time alignment between a model andsets of registration points;

FIGS. 6A and 6B illustrate ultrasound distribution error;

FIGS. 7A and 7B illustrate an example of non-rigid local registration;

FIGS. 8 and 9 illustrate the concept of “virtual touch,” whereby,according to various embodiments of the present invention, clinicianscan take numerous ultrasound images of an object (e.g., a heart) tocapture 4D surface registration points for the object;

FIG. 10 shows an example of a 4D heart model;

FIG. 11 shows an example of space registration; and

FIG. 12 shows an example of a real-time, high-resolution image output bythe image-processing module of the catheter navigation system of FIG. 1according to various embodiments of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

FIG. 1 is a simplified diagram of a catheter navigation system 10according to various embodiments of the present invention. As shown inFIG. 1, the catheter navigation system may comprise a catheter 12, whichmay be inserted into the body of a subject (not shown). The catheternavigation system 10 generates high resolution, 3D, real-time images ofthe environment of the catheter 12. The catheter navigation system 10 isespecially useful in producing high resolution, 3D, real-time images ofnon-rigid and/or topographically complex bodies, such as, for example,the human heart. In particular, the catheter navigation system 10 isespecially useful for procedures involving the left atrium such as leftatrium ablation.

As shown in FIG. 2, the catheter 12, according to various embodiments,may include an elongated flexible or rigid plastic tubular body 18having a distal end 20 and a proximal end 22. At the distal end 20, thecatheter 10 may include an ultrasound transducer 23 for transmittingultrasound and for receiving resultant echoes from surrounding objects(such as the inner walls of a heart when the catheter 12 is positionedinside the heart) so as to provide a field of view for the distal end 20of the catheter 12.

The catheter 10 may also include a magnetic position sensor 24, whichmay comprise a number of coils (not shown) for detecting signals emittedfrom a transmitter 26 of a position tracking system 28 (see FIG. 1). Forexample, the magnetic position sensor 24 may comprise three mutuallyorthogonal coils. The transmitter 26 may also include, for example,three mutually orthogonal emitting coils. The sensor 24 may detectmagnetic fields produced by the transmitter 26 and the output of thesensor 24 may be input to a position tracking processing unit 30 (seeFIG. 1) of the position tracking system 28. Based on the signalsreceived by the sensor 24, the position tracking processing unit 28 maycompute the position and orientation (roll, pitch, and yaw) of thesensor 24 (and hence the position and orientation of the distal end 22of the catheter 10). The processing unit 28 may comprise, for example, aPCB with a processor and firmware for computing the position of theposition 24 based on the received signals. The processing unit 28 mayalso input control signals to a drive control unit (not shown) for thetransmitter 26 to activate selectively the desired output from thetransmitter 26. According to various embodiments, the microBIRD positiontracking system from Ascension Technologies could be used for theposition tracking system 28. For more details, see published U.S. patentapplication Pub. No. 2004/0088136 A1, incorporated herein by reference.

Using a catheter 12 with both an ultrasound transducer 23 and a positionsensor 24 as described above not only allows the 3D coordinates, yaw,pitch, and roll of the catheter's tip (i.e., the distal end 20) to bedetermined, but also the 3D coordinates of every pixel in the ultrasoundimage as described below, thereby obviating the need to physically touchthe subject's heart with the catheter to record registration points, asis required in the prior art.

In various embodiments, the catheter 12 may also include aninterventional device, such as, for example, an ablation device, adrug/cell delivery device, a suture device, a pacing device, anocclusion/excision instrument, etc. In FIG. 2, the catheter 10 is shownas having an ablation device 32 for ablating an area of the subject,such as the inner walls of the subject's heart. Left atrium ablation isa procedure that attempts to cure atrial fibrillation. During thesurgery, an ablation catheter is inserted into the left atrium throughthe vein. Clinicians need to navigate the ablation catheter to ablatethe areas where the left and right pulmonary veins meet the left atrium.With the ultrasound transducer 23 and the ablation device 32 on onecatheter 10, the clinician may only need to insert one catheter into thesubject's heart to both (1) acquire the images of the heart and (2)perform the ablation.

According to other embodiments, two or more catheters could be used. Insuch embodiments, the clinician could insert a second catheter (theablation catheter) into the relevant area of the heart where the secondcatheter includes the ablation device. Preferably, such an ablationcatheter would also include a position sensor so that the positiontracking system 28 could track the position and orientation of thesecond catheter. That way, the clinician could use one catheter foracquiring the ultrasound images and the other catheter to perform theablation.

Referring back to FIG. 1, the received ultrasound images picked up bythe ultrasound transducer 23 are input to an image processing module 40of a computer device 42. The catheter 12 may be in communication withthe computing device 42 using any suitable type of communicationinterface, such as a wired interface (e.g., RS-232 or USB) or a wirelessinterface.

The image processing module 40, as described in more detail below, maygenerate high resolution, real-time 3D images of the object beingscanned by the catheter 10 (such as the inner walls of the subject'sheart) based on (i) the ultrasound images picked up by the ultrasoundtransducer 23, (ii) data regarding the position of the catheter 10 fromthe position tracking system 28, (iii) previously acquired highresolution image data of the object (e.g., the subject's heart), whichmay be stored in a memory unit 44, and (iv) timing signals (e.g.,electrocardiogram (ECG) signals from a ECG system 29). As described inmore detail below, the image-processing module 40 may first perform atime-space registration between a 4D model of the subject area (e.g.,the subject's heart) and surface registration points on the ultrasoundimages from the catheter 12. Once the registration is complete, theimage processing module 40 may generate and output real-time, highresolution 3D models of the subject (e.g., the subject's heart) on adisplay unit 46, which can be viewed by a clinician (e.g., a surgeon) asthe clinician moves the catheter 12 as part of a medical procedure(e.g., a left atrium ablation). The real-time images may be based onreal-time ultrasound image data being captured by the catheter 12 aspart of the procedure, the position of the catheter 12 (as determined bythe position tracking system 28), and on the timing signals (e.g., theECG signals).

The ECG system 29 may measure the electrical activity of the subject'sheart as is known in the art. As described in more detail below, the ECGsignals from the subject may be used to synchronize the ultrasound imagedata captured by the catheter 12 with the 4D heart model.

The computer device 42 may be implemented as any type of computer devicesuitable for the application. For example, the computer device 42 may bea personal computer, a workstation, etc. The image-processing module 40may be implemented as software code to be executed by a processor (notshown) of the computer device 40 using any suitable computer languageusing, for example, conventional or object-oriented techniques. Thesoftware code may be stored as a series of instructions or commands on acomputer-readable medium, such as a random access memory (RAM), aread-only memory (ROM), a magnetic medium such as a hard drive or afloppy disk, or an optical medium, such as a CD-ROM. The memory unit 44storing the previously acquired high-resolution image data of the objectmay also be a random access memory (RAM), a read-only memory (ROM), amagnetic medium such as a hard drive or a floppy disk, or an opticalmedium, such as a CD-ROM. The display unit 46 may be any suitable typeof monitor, such as a LCD display, for example. In addition, accordingto various embodiments, the position-tracking unit 30 could beimplemented as a module of the computer device 42.

FIG. 3 is a diagram of the process flow of the image-processing module40 according to various embodiments of the present embodiment. In thefollowing description, it is presumed that the catheter 10 is insertedinto a human heart and is that the image-processing module 40 is forgenerating high resolution, real time, 3D images of the heart, althoughit should be recognized that the catheter navigation system could beused for other purposes.

At step 50, the image processing module 40 creates a 4D model of thesubject's heart based on previously-acquired high resolution image dataof the subject's heart, which may be stored in memory unit 44. Thepreviously acquired high-resolution image data may be acquired by anysuitable means, including, for example, computer tomography (CT) scansor magnetic resonance imaging (MRI). The high-resolution image data ispreferably acquired before the catheterization such as, for example, oneday before under the assumption that the heart shape will not change insuch a short period of time. The high-resolution image data may depictthe subject's heart in three spatial dimensions at successive points (orphases) of the cardiac cycle. Thus, time is the fourth dimension.According to various embodiments, a CT scanner that generates a 3D heartscan at every 10% of a cardiac cycle may be used, so that in total theremay be ten 3D CT scans for one cardiac cycle. Such a CT scanner isavailable from General Electric.

To construct the 4D model, data for the left atrium may be segmented outmanually. Then the image-processing module 40 may extract the surfacemodel from the segmented CT data using, for example, the Marching Cube(MC) algorithm. The density threshold of MC algorithm may be set torepresent the surface between blood and heart muscle. Small floatingparts may be removed by discarding all triangles except those in thelargest connecting group of the model. Post processing may be performedto smooth the model and reduce artifacts based on geometry cues with animplicit integration method. For more details, see Mathieu Desbrun etal., “Implicit fairing of irregular meshes using diffusion and curvatureflow”, Computer Graphics, 33 (Annual Conference Series):317-324, 1999,which is incorporated herein by reference. For ten CT scans, ten surfacemodels can be extracted across one cardiac cycle, with each modelcorresponding to the shape of the left atrium at one time (or phase)within the cardiac cycle. This is the 4D heart shape model. The exampleof FIG. 10 shows two 3D heart models as different points in the cardiaccycle. Because the heart is beating, the shape changes through thecycle.

Next, at step 52, 4D surface registration points on the inner walls ofthe subject's heart are captured based on the ultrasound images capturedby the catheter 12. In the past, the clinician had to touch physicallythe catheter to the wall of the heart to capture each surface point. Incontrast, with embodiments of the present invention, the catheter 12 cancapture tens of thousands of high quality surface points within a fewminutes without physically touching the heart wall. The inventors referto this technique as “virtual touch.” “Virtual touch” can scan a rough4D heart shape (thousands of wall points) during the operation. Thisheart shape may not have the high resolution of a CT scan but it is whatthe heart is like during the operation. Such rough shape has much moreinformation than just a few points on the heart wall and it may greatlyimprove the accuracy and stability of registration.

With a catheter having a position sensor 24, when the clinician movesthe catheter 12 to a certain location and takes an ultrasound image ofthe heart, the clinician can see those pixels that are on the heartwall, as shown in the examples of FIGS. 8 and 9. Usually these pixelshave high gradient values and they can be detected by image processingalgorithms such as edge detectors. Not all of the pixels that are on theheart wall need to be detected, but rather only the ones with thehighest confidence levels. Using a catheter 12 with a position sensor 24allows not only the tip, but also every ultrasound image pixel's 3Dcoordinates to be computed based on information from the magneticposition tracking system 28. Thus, detecting those pixels that are onthe wall is equivalent to having physically moved the catheter to thatlocation, touched the heart wall and recorded the catheter tip's 3Dcoordinates. For one ultrasound image, it is not difficult to touchvirtually hundreds of points that are on the heart wall. Moreover, theclinician can move the catheter 12 inside the heart and take ultrasoundimages moving the catheter.

The locations and times of those ultrasound images are also recorded.For each image, one virtually touches the heart wall. The registrationpoints from one ultrasound image may have the same time coordinate aswhen the image is taken. The time coordinate may be between 0 and 1,where 0 means at the beginning of a cardiac cycle and 1 designates theend of a cardiac cycle. Intuitively, more registration points usuallygenerate a better registration result. By using a catheter with aposition sensor, one can record real time ultrasound video while movingthe catheter and, as a result, hundreds or thousands of registrationpoints can be captured.

Each 3D surface model extracted from the CT data may thereforecorrespond to a time tε[0, 1] (suppose t=0 is at the beginning of acardiac cycle and t=1 is at the end of a cardiac cycle) in a cardiaccycle when the heart was CT scanned. In the description to follow,C={C₀, C₁, . . . , C_(n-1)} is used to represent the 4D heart model,where n is the number of 3D models for one cardiac cycle. For example, nmay equal ten, corresponding to one 3D CT scan at every 10% of a cardiaccycle, so ten surface models may be extracted, corresponding to C={C₀,C₁, . . . , C₉}, where each model C_(i) represents the heart shape attime t=i/10, i=0, 1, . . . , 9. An example of this process is shown inFIGS. 4A-4D.

Referring back to FIG. 3, at step 54, the image processing module 15 mayregister the 4D heart model to the 4D surface registration points. Boththe 4D heart model and the 4D surface registration points may besynchronized with ECG signals (from the ECG system 29) as the timecoordinates. As shown in FIG. 3, the registration step may comprise twoprocesses: first, at step 56, a rigid, global space-time registrationbetween the 4D heart model and the 4D surface registration points; andsecond, at step 58, a local non-rigid registration to further improvethe registration accuracy. As explained below, the first process maycomprise, tentatively finding a transformation function F that can alignthe 4D surface registration points to the 4D heart model so that most orall the 4D surface registration points are on the inner heart wall ofthe model, as shown in the example of FIG. 11. FIG. 11 shows an exampleof registration points and a heart model before and after registration.As can be seen in the right-hand side image in FIG. 11, afterregistration the surface points are on the heart walls of the model. Thetime axis is also preferably aligned. The local non-rigid registration(step 56) may employ a free-form non-rigid registration.

For the global, rigid time-space registration, an initial spaceregistration can be done in a coarse-to-fine scheme. First, a roughalignment can be found based on the orientation of the subject on thebed. This rough alignment can be further refined by some points capturedon some designated regions of the heart. These regions should be easy tolocate solely from ultrasound images, such as the entrance region ofpulmonary veins. Then an alignment can be found so that these points arenear the same regions in the heart model as where they were captured.

Time registration may be equal to a correspondence scheme S thatindicates for any point set P_(i) in P, which C_(j) in C is itscorrespondence according to time. The heart model C={C₀, C₁, . . . , C₉}and the 4D surface registration points P={P₀, P₁, . . . , P₉} werepreferably captured both at t=0, 0.1, . . . , 0.9. Ideally, the timeregistration should be P_(i) corresponds to C_(i) for any i. Preferably,both the heart model and the surface registration points aresynchronized to the ECG signal to determine the time coordinate. Underdifferent conditions, sometimes the patient's heart beat rate is notstable, in which case the one-on-one correspondence of C_(i) with P_(i)may not be true. So time alignment may be necessary, as shown in FIGS.5A and 5B. In these figures, the upper row represents models and lowerrow represents point sets. The x-axis represents time. In the initialtime alignment, shown in FIG. 5A, a one-on-one correspondence may beassumed. The best correspondence scheme, shown in FIG. 5B, will be foundafter time alignment. For initial time registration, the correspondencescheme of P_(i) to C_(i) for any iε[0; 9] may be used.

The 4D registration algorithm employed by the image-processing module 40may assume errors have a Gaussian distribution. In that case, theregistration algorithm needs to find a space transformation function Fand a time correspondence scheme S that maximizes the expectation of loglikelihood of p(F(P)|S, C). The probability p(F(P)|S, C) can be definedas:

$\begin{matrix}\begin{matrix}{p\left( {{{F(P)}\left. {S,C} \right)} = {\prod\limits_{i}\; {p\left( {{F\left( P_{i} \right.}C_{si}} \right)}}} \right.} \\{= {\prod\limits_{i}\left( {\exp \left( {- {{{F\left( P_{i} \right)},C_{si}}}} \right)} \right)}}\end{matrix} & (1)\end{matrix}$

Here C_(si) is the corresponding model for P_(i) defined by scheme S.Each p(F(P_(i))|C_(si)) can be defined as an exponential function of theaverage distance from every point in F(P_(i)) to model C_(si), which iswritten as ∥F(P_(i)), C_(si)∥.

The number of n (number of CT scans within a cardiac cycle) and m(number of time spots the magnetic tracking system can record pointcoordinates) can be adjusted so that n=m×d, where d is an integer.According to various embodiments, the t coordinates of the magnetictracked points and the surface models from the CT scans can be assumedto be perfectly synchronized. Then any magnetic tracked point in pointset P_(i) should have the same t coordinate as heart model C_(ixd). Ifthe t in the CT scans and magnetic tracking system are not perfectlysynchronized, a definite one-on-one correspondence may not exist. IfP_(i) is assumed to be independent of all other C_(j) except thecorresponding one C_(ixd), then

P(F(P)|C)=p(F(P)|C ₁ ·p(F(P ₂)|C _(2xd))· . . . ·p(F(P _(m))|C_(n))  (2)

where n=m×d.

The probability of p(F(P_(i))|C_(j)) can de defined as the exponentialfunction of the average square distance from each point in F(P_(i)) tothe surface model C_(j):

$\begin{matrix}{{p\left( {{F\left( P_{i} \right)}C_{j}} \right)} = {\exp \mspace{11mu} \left( \frac{- {\sum\limits_{p_{k} \in P_{i}}{{p_{k} - C_{j}}}^{2}}}{P_{i}} \right)}} & (3)\end{matrix}$

The distance from a point to a model ∥P_(k)−C_(j)∥ may be defined as thedistance from point P_(k)εP_(i) to its nearest point in the surfacemodel C_(j). |P_(i)| is the number of points in P_(i).

To maximize the probability in equation (2), a modified ICP (IterativeClosest Point) algorithm may be used. For more details, see P. J. Beslet al., “A method for registration of 3-d shapes,” IEEE Trans. PatternAnalysis and Machine Intelligence, pages 14:239-256, 1992, which isincorporated herein by reference. The ICP algorithm iterativelyminimizes the distance between a set of points P and model C. In astandard ICP algorithm, each iteration contains two steps:

Compute the nearest point in Model C for each point in point set P.

Find a transformation F that can minimize the distance from P to theirnearest points, and then replace P with F(P) and repeat. According toembodiments of the present invention, during the first step, for eachpoint set P_(i), the nearest point set P_(near) _(_) _(i) can be foundonly from model C_(ixd). In order to maximize the whole p(F(P)|C) otherthan any single term of p(F(P_(i))|C_(j)), in the second step, all thepoint sets may be combined together as well as their nearest point sets,P_(combine)=U_(i=1) ^(m)P_(i) and P_(near) _(_) _(combine)=U_(i=1)^(m)P_(near) _(_) _(i), and a transformation F may be found like instandard ICP for this combined point set P_(combine) and P_(combine)_(_) _(near). In this way, a transformation function F that maximizesthe probability p(F(P)|C) can be found. The modified ICP can besummarized as:

Compute the nearest point set P_(near) _(_) _(i) for each P_(i) in theircorresponding model C_(ixd).

Combine point sets P_(combine)=U_(i=1) ^(m)P_(i) and P_(near) _(_)_(combine)=U_(i=1) ^(m)P_(near) _(_) _(i), and find a transformationfunction F that minimizes the distance from F(P_(combine)) to P_(near)_(_) _(combine), then replace the original P_(i) with F(P_(i)) andrepeat. There are many ways to accelerate ICP and make it more robust.Any or all those algorithms can be applied according to variousembodiments of the present invention. For example, a K-D treeacceleration may be used for the nearest neighbor search, and to ensureconvergence to a global minimum, a random perturbation may be added tothe found results and the ICP algorithm may be re-run.

During a heart operation, the t coordinates from the position trackingsystem 28 may not be perfectly aligned with those from high-resolutiondata (e.g., CT data) used in the 4D heart model because they arecaptured at different times. This means point set P_(i) may not trulycorrespond to model Card. Thus, both the time correspondence as well asthe space alignment preferably must be determined.

According to various embodiments, it may be assumed that for any pointset P_(i), the possible corresponding models are C_(ixd) and its closestneighboring models such as Cixd±k, for example, if four neighbors aretaken then k=[1, 2]. This assumption is valid because the timingdifference of the magnetic tracked points and CT models are known not tobe very large. All the candidate models for a point set P_(i) may bewritten as C_(ij) where j=[1, 5] if four neighbors are used and C_(ixd)itself. A scheme S may be defined that selects one C_(ij) as thecorresponding model for each point set P_(i).

The probability that is needed to maximize becomes p(F(P)|S, C), whichis difficult to compute directly since S is not known. According tovarious embodiments, an EM algorithm can be used that can maximize thisprobability by maximizing the expected log likelihood log(p(F(P)|S, C)),assuming S is a hidden random variable.

To use the EM algorithm, the Q function, or the expected log likelihood,must be determined. If S is a random variable, then the expected loglikelihood becomes:

$\begin{matrix}{{{Q\left( {{F(P)},S,C} \right)} = {\sum\limits_{S}{\log \; \left( {{{p\left( {{F(P)}\left. {S,C} \right)} \right)}{f\left( S \right.}C},{F^{({k - 1})}(P)}} \right)}}},} & (4)\end{matrix}$

log(p(F(P)|S, C)) is the log likelihood and f(S|C, F^((k-1))(P)) is theprobability of a correspondence scheme S given the data C and alignmentF^((k-1))(P) found in the last iteration. It can be computed by

$\begin{matrix}{{f\left( {{SC},{F^{({k - 1})}(P)}} \right)} = \frac{p\left( {{F^{({k - 1})}(P)}\left. {C,S} \right){p\left( S \right.}C} \right)}{\sum\limits_{S}{p\left( {{F^{({k - 1})}(P)}\left. {C,S} \right){p\left( S \right.}C} \right)}}} & (5)\end{matrix}$

where p(F^((k-1))(P)|C, S) is the probability of transformed points inthe last iteration given model C, and the corresponding model for eachpoint set P_(i) is determined by S. p(S|C) is the prior probability ofevery correspondence scheme S. Next is to maximize the Q function.

In the E step, the probability f(S|C, F^((k-1))(P)) is computed for anyS with the following formula:

$\begin{matrix}{{f\left( {{SC},{F^{({k - 1})}(P)}} \right)} = {\frac{1}{a}{p\left( {{F^{({k - 1})}(P)}\left. {C,S} \right){p\left( S \right.}C} \right)}}} & (6)\end{matrix}$

where a is the normalization term. The probability p(F^((k-1))(P)|C, S)may be computed with the formula Π_(i=) ^(m)p(F^((k-1))(P_(i))|C_(ij)),where the corresponding C_(ij) for P_(i) is defined by S. F^((k-1)) isknown, given the correspondence from S, p(F^((k-1))(P)|C_(ij) can becomputed with equation (3). Now each f(S|C, F^((k-1))(P)) is known andcan be represented by f(S) in the M step.In the M step, since the f(S) is known, which is the probability of anyS given C and F^((k-1)), the Q function in equation (4) becomes

$\begin{matrix}{Q = {\sum\limits_{S}{\log \; \left( {p\left( {{{F(P)}C},S} \right)} \right){{f(S)}.}}}} & \left( {6b} \right)\end{matrix}$

Then, to maximize the Q function is equivalent to maximizing thefunction below:

$\left. {\left. {\left. {\left. {\left. \left. {{\underset{F}{argmax}{\sum{\log \; \left( {{p(F)}(P)\left. {C,S} \right){f(S)}} \right)}}} = {\underset{F}{argmax}{\sum\limits_{S}{\log \; \left( {\sum\limits_{i = 1}^{m}{{p(F)}\left( P_{i} \right)}} \right.C_{ij}}}}} \right)_{S} \right){f(S)}} \right) = {\underset{F}{argmax}{\sum\limits_{S}\left( {{\sum\limits_{i = 1}^{m}{{p(F)}\left( P_{i} \right)}}C_{ij}} \right)_{S}}}} \right){f(S)}} \right) = {\underset{F}{argmax}{\sum\limits_{S}{\sum\limits_{i = 1}^{m}{{{F\left( P_{i} \right)} - C_{ij}}}}}}} \right){f(S)}$

where the corresponding model C_(ij) is defined by S. Here it can beseen that the problem becomes to find a transformation function F tominimize a weighted distance function. For each scheme S, the distancefunction ∥F(P_(i))−C_(ij)∥_(s) (in which the C_(ij) is the correspondingmodel of P_(i) defined by the particular S) is weighted by f(S) computedin E step. This minimization can be done by the modified ICP algorithmdescribed above. The only difference is here that a weight is added whenthe points are combined together.

Then the F^((k-1)) may be replaced with the new F and process repeat.The EM algorithm may stop when transformation function F does not changemore than a certain threshold or the alignment error is below a certainthreshold. The initial values of F may be computed under thecorrespondence scheme in the ideal situation where Pi corresponds toC_(ixd).

When “virtual touch” is used to collect surface registration points, theerror distribution is different from when a physical touch is used, asin the prior art. Pixels extracted from different regions of theultrasound image tend to have different error distributions and theregistration algorithm should be modified accordingly. The followingdescribes a detailed error model for “virtual touch” points.

Suppose one wants to know the error distribution of a pixel p that is dmm from the ultrasound image center O. To make the analysis easier, alocal coordinate system may be used whose origin is at p, the X axis ison the image plane and perpendicular to the radius from O through p, theY axis is the radius from image center O through p, and the Z axis isperpendicular to the image plane as shown in FIG. 6B.

The image plane's angular error has two components as shown in FIG. 6A,one is the off plane angle β, and the other is the on plane angle α. Allthese angles are based on rotation pivot at the ultrasound image centerO. These angles may be captured by the magnetic position sensor 24,which may have a few small coils inside it, which have known relativepositions. Based on the position readings of these coils, the angles canbe calculated. The position of the small coil may be assumed have anerror of normal distribution N(0, Σ_(c)) and the small coil has adistance d_(c) to the image center. Then, when the 3D coordinate of apixel is reconstructed which is d away from image center, it will havean error of normal distribution

$N\mspace{11mu} {\left( {0,{\frac{d}{dc}\sum\limits_{c}}} \right).}$

This means the error has been enlarged when the distance to the imagecenter increases. Such error is only within the X-Z plane of the localcoordinate system.

Ultrasound imaging devices calculate the echo energy of sound waves sentout from the image center to determine the surface's distance from theimage center. Because the ultrasound image plane is not infinitely thin,when a plane with a thickness hits a surface, it will generate a bandinstead of a thin line in the ultrasound image. The thickness of theimage plane increases proportionally to the distance from the imagecenter. The error along the radius or Y-axis of the local coordinatesystem can be assumed to have a normal distribution of N(0, dσ_(d))where d is the distance of the pixel from image center.

Finally, the ultrasound image center O may have a normal errordistribution. It will affect the 3D reconstruction of all the pixels inultrasound image because all the coordinates are calculated relative tothat of O. Combining all the errors together, in the local coordinatesystem of point p, the error can be modeled as a normal distributionwith a mean of zero and a covariance matrix of:

$\begin{matrix}{\sum\limits_{d}{= {{d{\sum\limits_{1}{+ \sum\limits_{O}}}} = {{d\; \begin{pmatrix}\sigma_{c_{1}} & 0 & 0 \\0 & \sigma_{r} & 0 \\0 & 0 & \sigma_{c_{2}}\end{pmatrix}} + \begin{pmatrix}\sigma_{O_{1}} & 0 & 0 \\0 & \sigma_{O_{2}} & 0 \\0 & 0 & \sigma_{O_{3}}\end{pmatrix}}}}} & (7)\end{matrix}$

σ_(c1), σ_(c2), and σ_(c3) are variance on the X, Y, and Z-axes of thelocal coordinate system of a pixel that is 1 mm away from the imagecenter. For a pixel that is d mm from image center, the covariancematrix is d times Σ₁. Σ_(O) is the position error of the image center O.

Assume a point p(x, y, z) captured on an ultrasound image whose centeris O and its normal is N. The local coordinate system's Y-axis will be(p−O)/d where d is the distance from p to O. The Z-axis will be theplane normal N. The X-axis will be (YxN). The origin of the localcoordinate system will be p. Then, a transformation matrix M can bedefined that transforms the global coordinate system into this localcoordinate system and the error distribution's covariance matrix Σ for Pcan be written as:

$\begin{matrix}{\sum\limits_{p}{= {M{\sum\limits_{d}M^{T}}}}} & (8)\end{matrix}$

The Σ_(d) is defined in equation (7) above. In the local coordinatesystem, Σ_(d) is a diagonal matrix, but in the global coordinate system,Σ_(p) usually is not a diagonal matrix. The covariance matrix of theerror distribution is dependent on p's position and the image plane'sorientation from which p is extracted. So any surface registration pointp will have a unique error distribution function N(0, Σ_(p)).

The registration algorithm maximizes the probability of F(P) and C whereP is the surface registration point set, F( ) is the currentregistration function, and C is the CT heart model. If the errordistribution function is assumed to be a normal distribution, tomaximize the probability equals to minimize the distance:

$\begin{matrix}{\underset{F}{argmin}{\sum\limits_{i = 1}^{m}{\left( {{F\left( p_{i} \right)} - C_{pi}} \right){\sum\limits_{p_{i}}^{- 1}\left( {{F\left( p_{i} \right)} - C_{pi}} \right)^{T}}}}} & (9)\end{matrix}$

where m is the number of points in P, p_(i) is the i'th point in pointset P, C_(pi) is the corresponding point of p_(i) on heart model C.Σ_(pi) is the covariance matrix for point p_(i) as defined in equation(8). In equation (9), the distance is weighted by

$\sum\limits_{p_{i}}^{- 1},$

so those points that have larger Σ_(pi) (larger errors) will be weighteddown accordingly. Points that are captured more accurately will havelarger weight in the sum of distance. And since the Σ_(pi) is notdiagonal, the correlation of different axes has been considered as well.

Referring back to FIG. 3, at step 58, a local, free-form non-rigidregistration may be performed to improve the accuracy of theregistration at step 54. As mentioned previously, the catheternavigation system 10 can be used for left atrium ablation procedures.The left atrium is a highly motile and non-rigid object. Non-rigid shapechanges result from multiple sources including: (1) the cardiac cycle orheart beat; (2) the breath cycle (i.e., the pressure changes of thelungs); and (3) other sources, like blood pressure, medicine and medicalinstruments. Preferably, a radial basis function is used to do the localnon-rigid registration as described below.

Suppose the intra-operative surface registration point set is P=(p₁, P₂,. . . , p_(n)), and the heart model from CT is C. After global rigidregistration, P and C still have difference D=(d₁, d₂, . . . , d). HereP is after the global registration. Each d_(i) may be defined asd_(i)=P_(i)−C_(pi), where C_(pi) is the nearest point of p_(i) in modelC. The free-form non-rigid registration should find a transformationfunction F_(local)(C) so that for any iε{1, 2, . . . , n},

p _(i) =F _(local)(C _(pi))  (10)

which means that after this non-rigid local transformation F_(local),all the surface registration points should be on the surface of thetransformed model F_(local)(C). Usually the F_(lcal)(p) at any 3Dposition p=(x, y, z) has the form of:

$\begin{matrix}{{F_{local}(p)} = {p + {\sum\limits_{i = 1}^{n}{a_{i} \cdot {\Phi \left( {{p - C_{p_{i}}}} \right)}}}}} & (11)\end{matrix}$

where ∥*∥ is the distance between two 3D points, a_(i) is a 3D vector,also known as the coefficient for each point C_(pi) and Φ( ) is a radialbasis function. For any point p, F_(local)(p) add an offset to p. Theoffset is a weighted sum of all coefficients a_(i) weighted by theradial basis function of the distance from p to C_(pi). Also, ∥p−C_(pi)∥can be computed. With the constraint in equation (10), enough equationsexist to solve each a_(i):

$\begin{matrix}{p_{i} = {C_{p_{i}} + {\sum\limits_{k = 1}^{n}{a_{k} \cdot {\Phi \left( {{C_{p_{i}} - C_{p_{k}}}} \right)}}}}} & (12)\end{matrix}$

A compactly supported positive definite radial basis function can bechose which ensures there is solution for equation (12):

$\begin{matrix}{{\Phi (X)} = {\varphi \left( \frac{X}{s} \right)}} & (13) \\{{{\varphi (r)} = {\left( {1 - r} \right)_{+}^{4}\left( {{3r^{3}} + {12r^{2}} + {16r} + 4} \right)}},{r \geq 0}} & (14)\end{matrix}$

where (1−r)₊=max(1−r, 0), s is a pre-defined scale. For more informationon compactly supported positive definite radial basis functions, see Z.Wu, “Multivariate compactly supported positive definite radialfunctions,” AICM, volume 4, pages 283-292, 1995, which is incorporatedby reference. This compactly supported radial basis ensures that eachsurface registration point only affects the non-rigid transformationlocally. Also, it can reduce the computational cost. Moreover, equation(14) has been shown to have C² continuity. Therefore, the F_(local) isC² continuous in the space and it satisfies the constraint shown inequation (11).

One example of this non-rigid local registration is shown in FIGS. 7Aand 7B. Suppose that in a 3D model of a plane, there are several surfacepoints that show the object is actually is curved. Rigid globalregistration cannot find a good alignment of the points and the model(see FIG. 7A). Using a radial basis local non-rigid registration, themodel can be modified according to the surface points locally andnon-rigidly. The result is a much better fit for the points (see FIG.7B).

Once the registration is complete, as shown in FIG. 3, as the clinicianmoves the catheter 12 as part of a medical procedure (e.g., a leftatrium ablation), at step 59, the image processing module 40 may outputreal-time, high resolution 3D models of the subject (e.g., the subject'sheart) on the display unit 46, as shown in FIG. 12. The real-timehigh-resolution image may be generated based on data 60, including theultrasound image data captured by the catheter 12, the position of thecatheter 12 (as determined by the position tracking system 28), and onthe timing signals (e.g., the ECG signals). The displayed real-time 3Dheart module can aid the clinician in performing the procedure.

In various embodiments, the present invention can provide the followingadvantages. First, it can be more reliable than conventional catheternavigation systems. Because one does not need to touch physically theheart wall with the catheter but just to move the catheter inside theleft atrium and take some pictures, there is no risk of pushing theheart wall too much nor the risk that a pixel is not actually on theheart wall.

Second, embodiments of the present invention can be faster than theprior art. When one takes one ultrasound image at one location with acatheter according to the present invention, one can capture tens orhundreds of points by virtual touch. This is much more efficient thanprevious methods. As a result, registration results could be moreaccurate. It is currently thought that the more registration pointstaken, the better the registration results. Because it is much fasterand more reliable to capture registration points with a catheteraccording to embodiments of the present invention, one can capture tensor hundreds of times more points in the same amount of time using thistechnology than is possible with previous methods. This will result inbetter registration results.

Third, there may be a higher confidence of ablation sites. Afterregistration, clinicians may navigate the catheter 12 based on theregistration result. The 3D position of the ablation tip will bedisplayed with the heart model in real time. When a clinician moves thecatheter near the site where the ablation should be performed, theultrasound images from the heart wall can be visually verified. Thisadds confidence over merely measuring the distance from catheter tipposition to the heart model's wall.

Various embodiments of the present invention are therefore directed to amethod for producing images of a subject (e.g., a person's heart). Themethod may comprise the steps of (1) acquiring ultrasound images of thesubject with a catheter comprising a position sensor; (2) capturing aplurality of 4D surface registration points in the acquired ultrasoundimages corresponding to points on the subject; and (3) registering ahigh resolution 4D model (e.g., a CT scan model) of the subject with theplurality of 4D surface registration points. The method may alsocomprise displaying high resolution, real-time images of the subjectduring a medical procedure based on the registration of the highresolution 4D model to the 4D surface registration points.

In another embodiment, the present invention is directed to a computerreadable medium having stored thereon instructions, which when executedby a processor, cause the processor to: (1) capture a plurality of 4Dsurface registration points from a plurality of input ultrasound imagescorresponding to points on a subject's heart; and (2) register a highresolution 4D model (e.g., a CT scan model) of the subject's heart withthe plurality of surface registration points. The computer readablemedium may also comprise instructions that cause the processor todisplay high resolution, real-time images of the heart during a medicalprocedure on the subject based on the registration of the highresolution 4D model to the 4D surface registration point.

In yet another embodiment, the present invention is directed to acatheter navigation system that comprises: (1) a catheter comprising anultrasound transducer and a magnetic position sensor; (2) a positiontracking system for tracking the position of the catheter based onsignals received by the magnetic position sensor; (3) an imageprocessing module in communication with the catheter and the positiontracking system for: (i) capturing a plurality of 4D surfaceregistration points from a plurality of ultrasound images of one or moreinner heart walls of a subject's heart acquired by the catheter; and(ii) registering a high resolution 4D model of the subject's heart withthe plurality of 4D surface registration points. The system may alsocomprise a display in communication with the image-processing module fordisplaying high-resolution images of the heart during a medicalprocedure on the subject based on the registration of the highresolution 4D model to the 4D surface registration points.

In yet another embodiment, the present invention is directed to a methodof performing a medical procedure on a subject (e.g., a heart of a humanbeing). The method may comprise: (1) inserting, by a clinician (e.g., asurgeon), a first catheter into the subject (e.g., the subject's heart);(2) acquiring ultrasound images of the subject with the first catheter;(3) capturing, with a programmed computer device in communication withthe catheter, a plurality of 4D surface registration points in theacquired ultrasound images corresponding to points on the subject (e.g.,inner heart walls of the subject); (4) registering, with the programmedcomputer device, a high resolution 4D model of the subject with theplurality of surface registration points; and (5) displaying, on adisplay in communication with the computing device, high resolution,real-time images of the subject (e.g., the subject's heart) during themedical procedure based on the registration of the high resolution 4Dmodel to the 4D surface registration points. In various implementations,the first catheter may comprise an interventional device. In otherimplementations, the clinician may insert a second catheter thatcomprises an interventional device into the subject.

While several embodiments of the present invention have been describedherein, it should be apparent that various modifications, alterations,and adaptations to those embodiments may occur to persons skilled in theart. It is therefore intended to cover all such modifications,alterations, and adaptations without departing from the scope and spiritof the present invention as defined by the appended claims

1. (canceled)
 2. A computer-implemented method, comprising: receivingscan data collected from a scan of a heart; extracting athree-dimensional (3D) surface model from the scan data, wherein the 3Dsurface model corresponds to a particular phase of a cardiac cycle ofthe heart; generating a four-dimensional (4D) heart model using the 3Dsurface model and a time associated with the particular phase of thecardiac cycle of the heart; receiving a 4D surface registration of theheart; and registering the 4D heart model with the 4D surfaceregistration.
 3. The computer-implemented method of claim 2, wherein the4D heart model and the 4D surface registration are synchronized withelectrocardiogram signals as time coordinates.
 4. Thecomputer-implemented method of claim 2, wherein registering the 4D heartmodel with the 4D surface registration further comprises creating arigid global space-time registration between the 4D heart model and the4D surface registration points.
 5. The computer-implemented method ofclaim 4, wherein creating the rigid global space-time registrationbetween the 4D heart model and the 4D surface registration pointscomprises determining a transformation function that aligns the 4Dsurface registration points with the 4D heart model.
 6. Thecomputer-implemented method of claim 5, wherein the transformationfunction aligns the 4D surface registration points with the 4D heartmodel, such that at least some of the 4D surface registration points arelocated on an inner heart wall of the 4D heart model.
 7. Thecomputer-implemented method of claim 4, wherein registering the 4D heartmodel with the 4D surface registration further comprises creating alocal non-rigid registration to further improve the registrationaccuracy.
 8. The computer-implemented method of claim 2, wherein thescan of the heart is a computer tomography (CT) scan.
 9. Thecomputer-implemented method of claim 2, wherein the scan of the heart isa magnetic resonance imaging (MRI) scan.
 10. The computer-implementedmethod of claim 2, wherein the plurality of 4D surface registrationpoints are captured from an ultrasound image of the heart.
 11. Thecomputer-implemented method of claim 10, wherein the ultrasound image ofthe heart is generated via a catheter comprising an ultrasoundtransducer and a position sensor.
 12. A catheter navigation system,comprising: a catheter comprising an ultrasound transducer and amagnetic position sensor; a position tracking system for tracking theposition of the catheter based on signals received by the magneticposition sensor; and an image processing module in communication withthe catheter and the position tracking system for: capturing a pluralityof four-dimensional (4D) surface registration points from a plurality ofultrasound images of one or more inner heart walls of a subject's heartacquired by the ultrasound transducer; and registering a 4D heart modelof the subject's heart with the plurality of 4D surface registrationpoints.
 13. The catheter navigation system of claim 12, wherein the 4Dsurface registration points correspond to points on the heart and arecaptured without the catheter touching any of the points on the heart.14. The catheter navigation system of claim 12, wherein the 4D heartmodel is constructed from a series of three-dimensional (3D) models atsuccessive time points.
 15. The catheter navigation system of claim 14,wherein the series of 3D models are generated prior to acquiring theultrasound images.
 16. The catheter navigation system of claim 14,wherein the series of 3D models are generated after acquiring theultrasound images.
 17. The catheter navigation system of claim 12,wherein the catheter is configured to be positioned within the subject'sheart and a portion of the catheter comprising the ultrasound transducerand the magnetic position sensor does not touch the one or more innerheart walls when capturing the plurality of ultrasound images of theheart.
 18. A non-transitory computer readable medium storing computerexecutable instructions, executable by a processor to: receive scan datacollected from a scan of a heart; extract a three-dimensional (3D)surface model from the scan data, wherein the 3D surface modelcorresponds to a particular phase of a cardiac cycle of the heart and isconstructed from a series of 3D surface models at successive timepoints; generate a four-dimensional (4D) heart model using the 3Dsurface model and a time associated with the particular phase of thecardiac cycle of the heart; receive a 4D surface registration of theheart, the 4D surface registration being generated via a cathetercomprising an ultrasound transducer; and register the 4D heart modelwith the 4D surface registration.
 19. The non-transitory computerreadable medium of claim 18, further comprising instructions executableby the processor to receive position data acquired from a positionsensor disposed on the catheter.
 20. The non-transitory computerreadable medium of claim 19, further comprising instructions executableby the processor to determine an orientation of the catheter based onthe received position data.
 21. The non-transitory computer readablemedium of claim 20, wherein the position sensor comprises a magneticpositioning sensor.